Christian Furman talks about her effort to improve care of older adults in Belize

Christian Furman, MD, medical director of the UofL Institute for Sustainable Health & Optimal Aging, and Margaret Dorward, Smock Endowed Chair in Geriatric Medicine, recently traveled to Belize as lead presenters at the country’s first National Health Insurance Geriatric Symposium. Furman, who also serves as interim chief for the Division of General Internal Medicine, Palliative Medicine & Medical Education, is the geriatrician specialist on a grant to increase the geriatric workforce in Belize for the improved care of older adults. UofL News had a chance to catch up with her about that work.

UofL News: What was the primary focus of your lecture?

Christian Furman: I gave five of the eight lectures, and my topics were geared to practitioners new to the field of geriatrics. I discussed both practical skills for working with older adults, as well as general information about the aging process. Topics included geriatric assessments, cognitive assessments for dementia, how to break bad news, advance care planning and end-of-life discussions.

UofL News: Is this part of an ongoing effort?

Christian Furman: This was my first trip to Belize; however, my leadership and mentorship role in developing the study of geriatrics in the country is part of a larger, ongoing effort. Belize does not have geriatricians, and there are only a couple facilities and programs that support older adults. Starting in 2014, through a three-year LIFE (Living Independently in Full Existence) grant with Catholic Health Initiatives Mission and Ministries Foundation and KentuckyOne Health, I began working with Dr. Omar Aviles, a primary care physician in Belize who works at Mercy Clinic, a clinic for older adults in Southside Belize City. I provided monthly telehealth consultations to Dr. Aviles through videoconferencing to discuss patient cases. In this way, I provide continuing mentorship and expertise on specific patients, and offer advice on how to develop an interdisciplinary geriatrics clinic and program. My goal in providing telecommunication consultations is to provide Dr. Aviles with instruction on geriatric medicine best practices that he can use in his practice and disseminate to his colleagues.

UofL News: What are the main challenges for older adults in Belize?

Christian Furman: In Belize, more than 41 percent of the population lives below the poverty level and, as in many countries, the effects of this are often most severely felt by a nation’s older adult population. Many older adults in Belize struggle to meet their basic needs across the major areas of health: social, housing, food access, transportation and medical care. These challenges are exacerbated by a lack of geriatricians in the country. These obstacles make accessing quality health care a challenge for many older adults. Having access to a geriatrician when we are older is essential to aging optimally. Just as we need pediatricians when we are young who understand the nuances of our health needs, so, too, is it essential to have someone who understands the complexities of aging. Many of the health care professionals in Belize have not been taught geriatric syndromes such as dementia, delirium, polypharmacy and how to complete a comprehensive geriatric assessment.

UofL News: What is the future of geriatric care in Belize?

Christian Furman: I am optimistic about the future of geriatric care in Belize. Even with just this one grant, we have been able to dramatically improve the skill set and awareness of geriatric issues among the Belizean health care workforce. Already many of the practice protocols at the Mercy Clinic have been updated to reflect the needs of their older adult population. Working with this practice has started a larger movement in the country to disseminate best practices more broadly – as seen by the first geriatrics symposium held in October. Dr. Aviles also has passed along many of our conversations to the National Health Insurance (NHI) of Belize, a branch of the Social Security Board of Belize. Due to this effort, NHI is even considering changes in the geriatric health care delivery throughout the country.

I have been honored to be part of this movement in Belize to improve the health and well-being of older adults. It has been deeply rewarding to help professionals integrate geriatric best-practice medicine into their practices. I am committed to doing all I can to increase the number of geriatricians – as illustrated by my work on this grant and in my efforts at UofL to add to our number of geriatric medicine fellows. I also am working to educate professionals through the institute’s Interprofessional Curriculum for the Care of Older Adults (iCCOA). The shortage of geriatricians is not only a challenge in Belize but also in the United States. According to the American Geriatrics Society, we need 30,000 more geriatricians by 2030 to meet the health care needs of the growing older adult population.